Senior couple reviewing health insurance documents at home in Costa Rica, planning for retirement over 60

Health Insurance Options for Expats Over 60

/ Healthcare & Wellness / By

If you’re over 60 and planning a move to Costa Rica, your health-coverage decision has three moving parts: the public system you’ll be required to join, the private options that get harder to buy with every birthday, and the hybrid arrangement many retirees end up using. Here’s how the three fit together in 2026 — and the questions to settle before you commit to a residency timeline.

The Short Version

Legal residents must enroll in the Caja (CCSS), Costa Rica’s public health system. It has no age cutoff and does not turn people away for pre-existing conditions — which is why it anchors most over-60 plans — though specific services and medications remain subject to CCSS rules, clinical criteria, its official drug formulary, and, for some voluntary-insured situations, qualifying periods. Private insurance adds speed and choice but gets expensive and restrictive at exactly your age. The practical result: plan around the Caja as your foundation, decide how much private care to layer on top, and — critically — keep your international or travel coverage until your Caja enrollment is actually active, because that takes longer than most newcomers expect.

The Coverage Gap Nobody Budgets For

Caja enrollment is a condition of legal residency — but it happens after your residency is approved, and residency processing commonly takes many months. The sequence runs: residency approval resolution from immigration (DGME) → CCSS enrollment → collecting your resident card (which generally requires proof of that enrollment). During the entire application period you are not in the public system. The single most expensive mistake an over-60 applicant can make is cancelling existing coverage on arrival: carry international or travel medical insurance through the full application window, and price that into your first-year budget.

The Caja: Your Foundation Once You’re In

What you get is broad public coverage: doctor visits, hospitalization, prescriptions from the CCSS’s official medication list, and treatment for chronic and pre-existing conditions, with no age limit. Two practical limits to understand: medications outside the official formulary (LOM) are not dispensed — if you depend on specific brand-name or specialty drugs, verify they’re listed or budget to buy them privately — and wait times for specialists and non-urgent procedures are the system’s well-known weakness.

On cost: contributions are not simply a percentage of whatever you declare. The CCSS determines a reference income through its own assessment at enrollment — for Pensionado residents it cannot be below the category’s US$1,000 monthly floor — and applies its contribution scale to that. Commonly cited 2026 estimates cluster near 10% of the reference income, but rates have changed in recent years and only the CCSS’s own assessment is authoritative: confirm current figures with the CCSS or your residency attorney before budgeting. (Estimates noted August 2026.)

Private Insurance: A Closing Window After 60

The private layer comes in two forms: INS, the state insurer, and international insurers, both offering policies usable in Costa Rica’s private hospitals. For new applicants over 60 the terms tighten fast — medical underwriting, pre-existing-condition exclusions, premiums that climb steeply, and most importantly maximum enrollment ages: reported cutoffs for new applicants commonly fall between about 65 and 70 depending on the insurer and policy, with existing policyholders typically able to renew beyond the cap they entered under. Those caps are the most time-sensitive fact in this entire guide and they change: if you’re in your mid-60s, confirm current enrollment age limits directly with insurers or a licensed local broker before building your timeline, and get every coverage decision — especially exclusions — in writing.

The Hybrid Reality

Many over-60 expats land in the same place: Caja for the foundation — chronic care, formulary prescriptions, hospitalization — plus private care for speed, chosen specialists, and comfort. The private share can be insurance-based or paid out of pocket: private consultations, labs, and imaging cost far less than in the United States, which makes self-pay realistic for routine outpatient care. It is not a plan for major events — surgery, cardiac care, cancer treatment, or ICU stays can still be financially serious, so model those scenarios before relying on self-pay. Where you live shapes the mix: the Central Valley puts CIMA and Clínica Bíblica within reach, while remote coastal areas lean harder on the public network — a genuine factor in choosing your town, covered in our region comparison.

Six Questions Before You Commit

  1. What coverage will carry me through the residency application period, before Caja enrollment is possible?
  2. What will the CCSS assess as my reference income, and what contribution follows from it?
  3. Are my current medications on the CCSS formulary — and what do they cost privately if not?
  4. Can I still buy private coverage at my age, and what exactly is excluded?
  5. Which EBAIS clinic and which hospital serve the exact town I’m considering?
  6. Does my coverage plan survive my 70s, not just my 60s?

Frequently Asked Questions

Is Caja enrollment really mandatory for residents?

Yes — enrollment in the CCSS is required for legal residents, with contributions based on a CCSS-assessed reference income (minimum US$1,000 for Pensionados). Enrollment happens after residency approval, so plan interim coverage for the application period.

Does the Caja cover pre-existing conditions?

The CCSS does not exclude members for age or pre-existing conditions the way private insurers can — a major reason it anchors over-60 plans. Specific services and medications remain subject to CCSS rules, clinical criteria, the official formulary, and availability, and some voluntary-insured situations carry qualifying periods.

Can I get private health insurance in Costa Rica at age 65 or older?

The window narrows quickly: reported new-enrollment cutoffs commonly fall between about 65 and 70, alongside exclusions and steep premiums. If this coverage matters to your plan, confirm current age limits directly with insurers or a licensed broker now rather than later.

Is Medicare usable in Costa Rica?

U.S. Medicare generally does not cover care outside the United States, with only narrow exceptions that don’t apply to living in Costa Rica. Plan your coverage independently of it.

Keep Planning

General planning information, not medical, insurance, or legal advice. Rules, contribution scales, formularies, and insurer policies change and vary by individual circumstances — verify current details with the CCSS, insurers, and a qualified local advisor. Last reviewed: August 31, 2026.